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Effect of Circadian Variability of Dipper Blood Pressure Induced by Irbesartan in Patients with NonDipper Essential Hypertension on Levels of Aldosterone

摘要:目的：观察厄贝沙坦治疗非杓型高血压患者降压效果及其杓型血压昼夜节律恢复情况,并观察治疗后血浆醛固酮水平的影响。方法:对杓型和非杓型两组原发性高血压患者分别给予150300 mg/d,观察降压效果及对血压昼夜节律的影响,并监测用药前后血浆醛固酮水平的变化。结果:所有高血压患者应用厄贝沙坦治疗前后收缩压及舒张压均有不同程度的下降,非杓型组夜间收缩压及舒张压的下降值与杓型相比有统计学差异,出现了明显的昼夜节律,血浆醛固酮水平出现了明显差异。结论:厄贝沙坦对非杓型高血压患者有良好的降压作用,并能恢复非杓型高血压患者的昼夜节律,向杓型血压变化。Abstract: Objective: To investigate the effect of blood pressure control and circadian variability of dipper blood pressure induced by irbesartan in patients with nondipper essential hypertension and to observe levels of aldosterone.after treatment.Methods:The patients were divided into dipper and nondipper groups. All patients were treated with irbesartan (150300 mg/d). The variability of circadian blood pressure were observed, and the levels of plasma aldosterone were monitored before and after treatment Results: After the treatment with irbesartan, the blood pressure in all patients were evidently reduced. The night blood pressure of the patient with nondipper essential hypertension had more significant improvement . The circadian variability was appeared. The levels of aldosterone had a significant difference between day and night. Conclusion:Irbesartan has significant effects for the patients with nondipper essential hypertension. It can induce a circadian variability and recover the dipper blood pressure from nondipper blood pressure.

The interpretation of antihypertensive drugs rational use guideline: RAAS inhibitors for hypertension complications

A real-world study on the impact of antihypertensive drugs on screening tests for primary aldosteronism

Objective To evaluate the effect of antihypertensive agents on primary aldosteronism (PA) screening test in the real world clinical practice; to explore the antihypertensive regimen and the corresponding ARR cut-off point of hypertension patients undergoing PA screening. Methods Hypertensive patients who underwent PA screening in the Department of Endocrinology & Metabolism of West China Hospital of Sichuan University between January 2010 and December 2020 were selected. According to the PA diagnostic criteria, patients were divided into the PA group and the essential hypertension (EH) group. The antihypertensive drugs, diastolic blood pressure, systolic blood pressure, blood electrolyte, plasma renin activity, plasma aldosterone, aldosterone versus renin activity (ARR) were collected before and after the washout period; aldosterone before and after captopril test, and aldosterone before and after saline infusion test were collected. The above indicators of two groups of patients were compared and analyzed. Results A total of 488 patients were included. Among them, there were 391 cases in the PA group and 97 cases in the EH group. There were statistically significant differences in age, systolic blood pressure, diastolic blood pressure, blood sodium, blood potassium, plasma renin activity, aldosterone, and ARR between the two groups (P<0.05). There was a significant difference in diagnostic results for PA screening between pre-eluting ARR and post-eluting ARR among patients taking 1-3 antihypertensive agents; however, there was no significant difference among patients taking 4 or more antihypertensive agents (P=0.547). Among the 488 patients included, calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor were the most used antihypertensive regimen. ARR≥23.6(ng/dL)/[ng/(mL·h)] could be used as the cut-off point of ARR screening PA before elution. Conclusions When PA screening is performed in patients with hypertension, ARR with the can be directly screened for patients taking 4 or more antihypertensive drugs. As to patients taking 1-3 antihypertensive drugs, such as calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor, ARR≥23.6 (ng/dL)/[ng/(mL·h)] can be selected as the cut-off value.